Evaluation and practice of temporary hemodialysis catheter removal for critically ill patients by Chinese ICU nurses: a multicenter cross-sectional study.

BACKGROUND: Establishing temporary vascular access is essential for critically ill patients undergoing continuous renal replacement therapy (CRRT) in the intensive care unit (ICU). However, such access increases the risk of catheter-related complications, which may exacerbate clinical conditions and even threaten patient survival. This study aimed to investigate current practices and associated evaluation factors regarding temporary hemodialysis catheter removal among Chinese ICU nurses, to clarify why catheters are often retained for prolonged periods after CRRT discontinuation and when removal is typically performed.

METHODS: A multicenter, cross-sectional questionnaire survey was conducted among ICU nurses across 30 provinces in China. Data were collected on current practices related to temporary blood purification catheter removal. Chi-square tests were used to compare practices and evaluation factors among nurses with different characteristics. Given the exploratory nature of this study, we did not adjust the significance level for multiple comparisons.

RESULTS: A total of 704 ICU nurses from 32 provincial-level regions in China were included, with 50.14% (353/704) from Central China. The most frequently reported indication for catheter removal was "no longer required for clinical treatment" (394/681, 57.86%). Missing data in ranking questions were handled by pairwise deletion, with percentages calculated only from valid responses. The leading reason for temporary catheter retention after CRRT cessation was "high patient bleeding risk" (284/635, 44.72%). For functionally intact catheters, 65.34% (460/704) of nurses determined removal based on assessment results. The femoral vein was the preferred insertion site (75.74%, 515/680). Daily assessment of catheter retention necessity was supported by 89.35% (629/704) of nurses. Over 80% of respondents judged removal eligibility based on laboratory test results or clinical experience. Physicians were primarily responsible for removal decisions (65.77%, 463/704) and performance of the procedure (66.9%, 471/704). Only 55.4% of nurses had received formal training on catheter removal. Significant differences were observed in removal timing, retention reasons, and management among nurses with different professional characteristics.

CONCLUSION: ICU nurses in this study demonstrated heterogeneous practices and evaluation criteria for temporary CRRT catheter removal, guided mainly by personal clinical experience and local departmental protocols. Only approximately half of the nurses had received relevant training, and no consensus existed regarding optimal timing and duration for catheter removal. Standardized nursing assessment and recommendation protocols are urgently needed.